The Physiological Aspects of Extracorporeal Circulation

Hudson, William A.

doi:10.1093/bja/31.9.378

Cited by 5 publications

(1 citation statement)

References 11 publications

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“…Extracorporeal circulation was not feasible until 1935, when a purified preparation of a physiological reversible agent became available for the safe and effective anticoagulation of human patients (80). This agent, heparin, first discovered in 1916 by Jay McLean, was the most universally used anticoagulant in the pioneering days of cardiopulmonary bypass and little has changed in over 50 years (81)(82)(83). It is the only consistent element of anticoagulation therapy for CPB.…”

Section: Evolution Of Anticoagulation Use and Monitoring During Cardi...mentioning

confidence: 99%

Management and Monitoring of Anticoagulation for Children Undergoing Cardiopulmonary Bypass in Cardiac Surgery

Gruenwald¹,

Manlhiot²,

Crawford‐Lean³

et al. 2010

J Extra Corpor Technol

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Cardiopulmonary bypass (CPB) creates a pro-coagulant state by causing platelet activation and inflammation leading to thrombin generation and platelet dysfunction. It is associated with severe derangements in normal homeostasis resulting in both thrombotic and hemorrhagic complications. This derangement is greater in children with congenital heart disease than in adults because of the immaturity of the coagulation system, hemodilution of coagulation factors, hyperreactive platelets, and in some patients, physiologic changes associated with cyanosis. During CPB, an appropriate amount of heparin is given with the goal of minimizing the risk of thrombosis and platelet activation and at the same time reducing the risk of bleeding from over anticoagulation. In young children, this balance is more difficult to achieve because of inherent characteristics of the hemostatic system in these patients. Historically, protocols for heparin dosing and monitoring in children have been adapted from adult protocols without re-validation for children. Extreme hemodilution of coagulation factors and platelets in young children affects the accuracy of anticoagulation monitoring in children. The activated clotting time does not correlate with plasma levels of heparin. In addition, recent studies suggest that children need larger doses of heparin than adults, because they have lower antithrombin levels, and they metabolize heparin more rapidly. Preliminary studies demonstrated that the use of individualized heparin and protamine monitoring and management in children is associated with reduced platelet activation and dysfunction and improved clinical outcomes. However, this review article clearly establishes that further studies are necessary to obtain evidence-based protocols for the proper management of anticoagulation of children undergoing cardiopulmonary bypass.

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Section: Evolution Of Anticoagulation Use and Monitoring During Cardi...mentioning

confidence: 99%

Management and Monitoring of Anticoagulation for Children Undergoing Cardiopulmonary Bypass in Cardiac Surgery

Gruenwald¹,

Manlhiot²,

Crawford‐Lean³

et al. 2010

J Extra Corpor Technol

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Psychiatric complications following cardiac surgery

Hazan

1966

The Journal of Thoracic and Cardiovascular Surgery

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Effect of remote ischaemic preconditioning on mortality and morbidity after non-cardiac surgery: meta-analysis

et al. 2021

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Background Remote ischaemic preconditioning (RIPC) has been shown to have a protective role on vital organs exposed to reperfusion injury. The aim of this systematic review was to evaluate the effects of non-invasive RIPC on clinical and biochemical outcomes in patients undergoing non-cardiac surgery Methods A systematic literature search of PubMed, EMBASE, Scopus, and Cochrane databases was carried out in February 2020. RCTs investigating the effect of non-invasive RIPC in adults undergoing non-cardiac surgery were included. Meta-analyses and trial sequential analyses (TSAs) were performed on cardiovascular events, acute kidney injury, and short- and long-term mortality. Results Some 43 RCTs including 3660 patients were included. The surgical areas comprised orthopaedic, vascular, abdominal, pulmonary, neurological, and urological surgery. Meta-analysis showed RIPC to be associated with fewer cardiovascular events in non-cardiac surgery (13 trials, 1968 patients, 421 events; odds ratio (OR) 0.68, 95 per cent c.i. 0.47 to 0.96; P = 0.03). Meta-analyses of the effect of RIPC on acute kidney injury (12 trials, 1208 patients, 211 events; OR 1.14, 0.78 to 1.69; P = 0.50; I2 = 9 per cent), short-term mortality (7 trials, 1239 patients, 65 events; OR 0.65, 0.37 to 1.12; P = 0.12; I2 = 0 per cent), and long-term mortality (4 trials, 1167 patients, 9 events; OR 0.67, 0.18 to 2.55; P = 0.56; I2 = 0 per cent) showed no significant differences for RIPC compared with standard perioperative care in non-cardiac surgery. However, TSAs showed that the required information sizes have not yet been reached. Conclusion Application of RIPC to non-cardiac surgery might reduce cardiovascular events, but not acute kidney injury or all-cause mortality, but currently available data are inadequate to confirm or reject an assumed intervention effect.

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The Physiological Aspects of Extracorporeal Circulation

Cited by 5 publications

References 11 publications

Management and Monitoring of Anticoagulation for Children Undergoing Cardiopulmonary Bypass in Cardiac Surgery

Management and Monitoring of Anticoagulation for Children Undergoing Cardiopulmonary Bypass in Cardiac Surgery

Psychiatric complications following cardiac surgery

Effect of remote ischaemic preconditioning on mortality and morbidity after non-cardiac surgery: meta-analysis

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